hahaha. Yeah. It's sounds like something us Unity users need to come up with since it's complicated and not something universal to all Spine runtimes. But I agree. From what I know of the code, it is something the Spine-Unity/C# can accomodate as it is.
I'd love to do ragdoll with Spine.
I think if that other Spine-Unity runtime that uses individual GameObjects is working, that's easier to ragdoll. All you'd have to do is remove the spine component and add Box2D joints and colliders and rigidbodies. Or swap out two things, one generated by that other runtime.
The other thing I'd like is physics-controlled bones in Spine-Unity. So we could have a Spine-skinned-mesh cloth or hair parts, and have Box2D control its waving around physics-y by simulating physics on the Spine.Bones.